Chapters Transcript Video Infantile Versus Childhood Posterior Urethral Valve Diagnosis: Management Patterns And Clinical Outcomes At Opposite Ends Of The Spectrum Detailed by Andrew Gabrielson, MD, PGY-4, at the AUA Annual Meeting 2023. Patients with posterior urethral valves are typically diagnosed in the prenatal or antenatal period. However, a subset of patients may be diagnosed in later in childhood uh due to mild obstruction from their valve leaflets to better defined management patterns as well as outcomes of patients with delayed posterior urethral val diagnosis. We compared post ablation management and clinical outcomes of patients with infantile, uh which we defined as being diagnosed and managed less than one year of age versus those that were diagnosed in childhood, which we defined as age five or later. And the reason that we did this is to gain insight into the pathologies at opposite ends of the P U V spectrum. We performed a retrospective cohort study using a large multi center uh research network. Uh from 2006 to 2022 we defined two cohorts. The infantile arm were diagnosed and managed within one year of life and the childhood arm was had an index diagnosis and valva population. After age five, our primary end point were looking at rates and time to first use of very various bladder management medications including antispasmodics and alpha blockers as well as uh surgical um interventions such as Metro Monty and Taoists blast, as well as bladder Botox and C IC. Lastly, we also collected data about uh uh C K D chronic kidney disease and uh and looked at rates of renal transplantation. We included about 600 patients in this study, 300 in the infantile arm and about 250 in the childhood arm with about 10 years of follow up in both arms. Not surprisingly, the younger arm that infantile arm were significantly more likely to have hydro nephrosis seen on prenatal ultrasound. And that group is also most likely to develop neonatal sepsis. The childhood arm had a much greater heterogeneity in the presentation of their symptoms. Some developed new urging continence, nocturnal and uresis hematuria, as well as urinary retention in an otherwise toilet trained child following valve ablation. Uh Many of those patients in the infantile arm developed fibri U T I S and did so significant significantly more often than those in the childhood arm. Ultimately, the most common management strategy for both arms was antispasmodic medication and about 40% in both arms. Uh patients in the infantile arm were significantly more likely to uh be started on C IC as well as undergo inos tosti metro monte or secondary cutaneous vasotomy. When looking at rates of C K D. We found that patients in the infantile arm had a roughly two fold, increased risk of nearly each stage of chronic kidney disease as well as a 10% rate of progression to end-stage renal disease. From these data, we can gain several conclusions. First, early medical management with antispasmodic medication was common uh in both patient groups with which is consistent with recent evidence suggesting that antispasmodics may attenuate progression of severe bladder dysfunction and compliance changes in patients with P U V. Additionally, patients with a childhood P U V diagnosis were disproportionately managed with more conservative strategies compared to their infantile diagnosis counterparts. But despite higher utilization of conservative strategies, the childhood arm had superior renal outcomes and low low rates of progression to invasive treatments. So ultimately, when taken together, these findings suggest that a very late diagnosis of P U V reflects an overall milder disease process with more favorable renal outcomes. Created by
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